Gastroesophageal reflux

General information

Gastroesophageal reflux disease (GERD) is a very common condition, occurring when the contents of the stomach flow back into the tube connecting the mouth to the stomach (oesophagus). This reflux occurs due to a malfunction in the lower oesophageal sphincter, a circular band of muscle at the lower end of the oesophagus that typically relaxes to allow food and liquids to enter the stomach before closing again.

The most common symptoms are a burning sensation in the stomach and chest, generally after eating and sometimes worsening at night. Other symptoms, termed atypical but no less frequent, include chest pain, difficulty swallowing, regurgitation (food returning to the mouth), a sensation of a lump or "constant mucus" in the throat, dental erosion, chronic cough, laryngitis, asthma, and sleep disturbances.

GERD may be mild with minimal symptoms and easy to control, but it can also be severe, causing frequent symptoms, reduced quality of life, and sometimes complications. GERD can lead to oesophageal ulcers, strictures (oesophageal narrowing due to continuous inflammation), digestive bleeding, Barrett’s oesophagus, and cancer.

Causes and risk factors

The cause of the disease is frequent acid reflux, which irritates the normal lining of the oesophagus and upper airway due to dysfunction of the lower oesophageal sphincter.

Some situations may increase the risk of developing the disease: obesity, pregnancy, having a hiatal hernia (a condition where part of the stomach protrudes into the thorax through the diaphragm), some conditions (scleroderma, gastroparesis, etc.), smoking, certain foods (chocolate, fatty foods, alcohol, large meals, etc.), and some medications (benzodiazepines, some antihypertensives, etc.).

When to see a doctor

Book a medical appointment if you frequently experience reflux symptoms (more than twice a week) or if you regularly take medication.

You should seek immediate medical care if you have symptoms of alarm such as difficulty swallowing, pain when swallowing, vomiting, anaemia, weight loss or loss of appetite, or black stools.

If you have chest pain radiating to the throat or left arm with a feeling of pressure, go immediately to hospital as this could indicate a cardiac problem. If cardiac pathology is ruled out, you should be assessed by a digestive specialist for possible atypical reflux.

Conventional treatment

GERD treatment should be individualised. The cornerstone of treatment involves lifestyle changes (habits, diet, etc.) alongside pharmacological treatment, primarily using proton pump inhibitors (PPIs), which are known to have some side effects. Most people manage symptoms with medication and lifestyle changes; however, some patients need high medication doses or surgery to alleviate their symptoms. Until recently, fundoplication, a surgical procedure that creates a valve between the oesophagus and stomach, was the only option when medication was insufficient or undesirable as a lifelong treatment, although it carries risks and side effects. Since March 2018, our unit has offered a novel endoscopic technique to treat gastroesophageal reflux.

New non-surgical technique for treating gastroesophageal reflux: TIF 2.0 with EsophyX-Z

We currently have the option of performing a transoral incisionless fundoplication (TIF) using the EsophyX-Z system.

The EsophyX device is designed to reconstruct the gastroesophageal valve (GEV) and help restore its function as a reflux barrier by creating a 2-3 cm, 270º fundoplication from within the stomach without incisions, guided by endoscopy. It is indicated for patients with a loose cardia or a small hiatal hernia (2 cm).

This procedure offers a surgical alternative with many benefits such as greater patient comfort and fewer associated risks.